Abstract
Thrombolysis is associated with reduced disability for selected patients who have suffered ischemic stroke. However only a fraction of all patients who have suffered this type of stroke receive thrombolysis. The short time window of 4.5 h in which treatment is licensed means that rapid care and well-organised pathways are essential. We studied measures to increase the uptake of thrombolysis through a better understanding of the hospital delays which lead to a lack of timely brain scanning and diagnosis. We examine the factors influencing the number of thrombolysed patients, the time between arrival at hospital and the administration of thrombolysis (door to needle time).
Our analysis is based on the Scottish Stroke Care Audit (SSCA) data covering all stroke patients admitted to hospitals in Scotland in 2010, as well as on interviews with stroke care staff in Scotland. The data show significant variation in the speed of scanning, thrombolysis treatment and numbers of patients receiving treatment among hospitals. In the best performing hospital, 68% of patients arriving within 4 h of stroke onset are scanned in time for thrombolysis compared with 40% on average and 5% in the worst performing hospital.
We model the system as a discrete-event simulation following the patient journey, starting when patients have a stroke and ending at thrombolysis for those who qualify. The simulation results show that just improving the performance of all hospitals to the level of the best performing hospital would (even without improvements in onset to arrival times) increase the thrombolysis rate from 6% (in 2010) to 11% of all admitted stroke patients in Scotland. By 2013 9% of patients were receiving thrombolysis, suggesting there is still room for improvement.
Our analysis is based on the Scottish Stroke Care Audit (SSCA) data covering all stroke patients admitted to hospitals in Scotland in 2010, as well as on interviews with stroke care staff in Scotland. The data show significant variation in the speed of scanning, thrombolysis treatment and numbers of patients receiving treatment among hospitals. In the best performing hospital, 68% of patients arriving within 4 h of stroke onset are scanned in time for thrombolysis compared with 40% on average and 5% in the worst performing hospital.
We model the system as a discrete-event simulation following the patient journey, starting when patients have a stroke and ending at thrombolysis for those who qualify. The simulation results show that just improving the performance of all hospitals to the level of the best performing hospital would (even without improvements in onset to arrival times) increase the thrombolysis rate from 6% (in 2010) to 11% of all admitted stroke patients in Scotland. By 2013 9% of patients were receiving thrombolysis, suggesting there is still room for improvement.
| Original language | English |
|---|---|
| Pages (from-to) | 50-60 |
| Number of pages | 11 |
| Journal | Operations Research for Health Care |
| Volume | 6 |
| Early online date | 11 Sept 2015 |
| DOIs | |
| Publication status | Published - Sept 2015 |
Bibliographical note
We are grateful to David Murphy of the SSCA for providing data and we acknowledge the help of all who enter data into SSCA. We acknowledge the support of the UK Engineering and Physical Science Research Council’s Health and Care Infrastructure Research and Innovation Centre (HaCIRIC). Part of Steffen Bayer’s time was funded by the Singapore’s Medical Research Council under its STaR Award Grant (grant number NMRC/STaR/0005/2009). The sponsors did not influence study design, analysis or interpretation.Keywords
- stroke care
- Telestroke
- thrombolysis
- hospital decay
- discrete-event simulation